Kuo Andy, Yue Sophie, Kaelber David C, Li Ang
Department of Ophthalmology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
Ophthalmic Epidemiol. 2025 Aug;32(4):374-381. doi: 10.1080/09286586.2024.2401046. Epub 2024 Oct 10.
To investigate racial and ethnic inequalities in prescription of Netarsudil, one of two anti-glaucoma medications with a novel mechanism to be introduced in the past two decades, among patients with primary open-angle glaucoma.
This retrospective cohort matched study, based on electronic health records consisting of 92 million patients in the U.S, utilized Propensity Score Match, Relative Risk, Kaplan-Meier survival, and Chi-Square analysis to identify differences in rates of Netarsudil prescribing between racial and ethnic groups (non-Hispanic White, non-Hispanic Black, non-Hispanic Other Race, and Hispanic).
Among the sample of patients that met Primary Open-Angle Glaucoma inclusion criteria (55,942), more White patients were prescribed Netarsudil than Black; (RR:1.24, 95% CI: 1.15-1.34) and Hispanic; (RR:1.63, 95% CI: 1.29-2.07) patients. White patients had higher prescription rates than Black patients in the Midwest (6.5% vs 4.2%; < 0.0001) and West (11.2% vs 7.1%; = 0.0002), higher rates than Hispanic patients in the South (4.9% vs. 2.0%; < 0.0001) and West (11.2% vs. 7.8%; < 0.008), but lower rates than Black patients in the Northeast (7.2% vs. 13.2%; < 0.0001).
Differences in Netarsudil prescription rates within the United States exist between White and Black patients, and White and Hispanic patients. These differences exist when stratified by regions within the U.S. by varying degrees. Future studies are needed to investigate factors contributing to disparities in accessing new medications and to identify ways to eliminate such barriers to improve equity in care of glaucoma patients, especially among those historically disadvantaged.
在原发性开角型青光眼患者中，研究奈他洛尔（在过去二十年引入的两种具有新作用机制的抗青光眼药物之一）处方方面的种族和族裔不平等情况。
这项回顾性队列匹配研究基于美国9200万患者的电子健康记录，利用倾向得分匹配、相对风险、Kaplan-Meier生存分析和卡方分析，来确定种族和族裔群体（非西班牙裔白人、非西班牙裔黑人、非西班牙裔其他种族和西班牙裔）之间奈他洛尔处方率的差异。
在符合原发性开角型青光眼纳入标准的患者样本（55942例）中，开具奈他洛尔处方的白人患者多于黑人患者（相对风险：1.24，95%置信区间：1.15 - 1.34）和西班牙裔患者（相对风险：1.63，95%置信区间：1.29 - 2.07）。在中西部地区，白人患者的处方率高于黑人患者（6.5%对4.2%；P < 0.0001），在西部地区也是如此（11.2%对7.1%；P = 0.0002）；在南部地区，白人患者的处方率高于西班牙裔患者（4.9%对2.0%；P < 0.0001），在西部地区也是如此（11.2%对7.8%；P < 0.008），但在东北地区，白人患者的处方率低于黑人患者（7.2%对13.2%；P < 0.0001）。
在美国，白人患者与黑人患者以及白人患者与西班牙裔患者之间在奈他洛尔处方率上存在差异。这些差异在美国不同地区分层时不同程度地存在。未来需要开展研究，以调查导致获取新药方面存在差异的因素，并确定消除此类障碍的方法，以改善青光眼患者护理的公平性，特别是在那些历史上处于不利地位的患者中。
